Abdominal pain examination. Stomach ache. Diagnostic tests. When to seek medical attention for abdominal pain

Pain that appears near the navel and travels to the lower right abdomen may indicate appendicitis, inflammation of the appendix (ridge of the intestine). Most serious cases will require surgery to remove the appendix. With advanced appendicitis, the appendix may burst. If you experience severe pain or tenderness in the right lower abdomen, abdominal pain when walking, nausea, vomiting or loss of appetite, or fever, you should see your doctor immediately.

Pain in the lower left abdomen can be a symptom of diverticulitis. Diverticulitis occurs when small, spherical capsules called diverticula form in the walls of the colon, which subsequently become infected and inflamed. Other symptoms of diverticulitis include fever, nausea, vomiting, chills, seizures, and constipation. Treatment for diverticulitis usually involves clearing the colon of infections and inflammation. The doctor may prescribe antibiotics and / or pain relievers, a liquid diet, and bed rest for several days. In some cases, treatment for diverticulitis requires a hospital stay. If complications arise, surgery may be necessary.

The best way to prevent a diet high in fiber. Dietary fiber promotes proper digestion and relieves pressure in the colon. Gradually increase the amount of fiber in your daily diet and drink plenty of fluids. Timely bowel movements can also help prevent diverticulitis. The accumulation of waste products from the digestive system causes an increase in pressure in the colon.

Acute pain in the right hypochondrium, aggravated after eating, indicates the presence of a lesion of the gallbladder. Gallbladder diseases include stones and inflammation of the gallbladder(cholecystitis). If complications arise, gallbladder damage can have other symptoms, along with pain in the peritoneum. These include: jaundice (yellowing of the skin and whites of the eyes), severe fever, and chills. Sometimes people with do not experience any symptoms at all. If pain occurs regularly in the right hypochondrium, you should consult a doctor.

Gallbladder pain attacks can be managed in a number of ways, from simply waiting (observing symptoms for a while, not receiving any treatment) to taking medications and even surgery. You can also reduce the symptoms of gallbladder disease by reducing the amount of fat in your diet.

Abdominal pain, relieved after a bowel movement and accompanied by diarrhea or constipation, may indicate a common gastrointestinal disorder, the cause of which has not yet been established. When irritable bowel syndrome occurs, the walls of the intestines are compressed sometimes too much, sometimes too weakly, sometimes too slowly, and sometimes, on the contrary, too quickly. Symptoms of this disease include: bloating, increased gas production, slimy stools, a constant desire to empty the intestines.

This syndrome cannot be dealt with with surgical methods or medications. However, worsening of the condition can be prevented by drinking plenty of water, increasing the amount of fiber in the diet, reducing the amount of caffeine consumed, and increasing exercise.

Acute burning pain in the upper and middle parts of the abdomen (between the sternum and the navel) may indicate the presence of an ulcer. An ulcer is a wound that forms in the tissues of the stomach or upper intestine. There are many causes of ulcers. Smoking, taking, ibuprofen, or other nonsteroidal anti-inflammatory drugs (NSAIDs) may play a role. An ulcer can also form if the stomach cannot protect itself from strong stomach acid.

Helicobacter pylori, a bacterium that lives in the stomach, can also cause ulcers. Stress and spicy foods cannot cause ulcers. Heartburn alone cannot indicate this disease. Severe pain like heartburn can also be caused by a less serious condition called gastroesophageal reflux disease.

In women, abdominal pain may indicate problems with the reproductive system. Pelvic pain that occurs every month before menstruation can indicate endometriosis, a condition in which tissue particles from the uterus move through the fallopian tubes and enter the ovaries, pelvis, bladder, and other organs. Soreness in the lower abdomen may indicate pelvic inflammation (infection of the tissues of the uterus, fallopian tubes, or ovaries).

In women of childbearing age, an ectopic pregnancy can also cause sharp, sharp or stabbing pain in the peritoneum, accompanied by vaginal bleeding, an irregular menstrual cycle, and pain radiating to the shoulders. Ovarian cysts and uterine fibroids can also cause abdominal pain in women.

Other cases of abdominal pain include: urinary tract infections, food poisoning and allergies, hernia, and lactose intolerance.

Causes of abdominal pain

In most cases, abdominal pain is caused by quite common causes, such as emotional distress, overeating, or the flu. However, similar pain symptoms can be caused by more serious diseases. Only a doctor can clearly determine the cause of pain.

Symptoms

If you experience mild pain that appears sporadically for less than 4 weeks, you can try to cope with the problem yourself.

Urgent medical attention is needed for the following conditions:

• pain accompanied by fever, jaundice, dark urine, severe nausea or vomiting, light pasty stools;
• sharp sharp stabbing pain in the abdominal cavity, accompanied by vaginal bleeding, irregular menstrual cycle, pain radiating in the shoulders;
• severe persistent pain in the peritoneum after injury;
• unexpected very severe pain lasting more than 2 hours.

Urgent hospitalization is required if the following symptoms appear:

• abdominal pain accompanied by sudden bright red rectal bleeding or vomiting of blood or a substance that looks like coffee grounds;
• dizziness, delirium, rapid pulse, cold clammy skin.

What can you do for stomach pain

Mild pain not associated with ulcer disease, diverticulitis, or gallbladder disease can be treated at home. Give your body enough time to rest. To relieve pain, take simple pain relievers or antispasmodics (eg, paracetamol). Do not use acetylsalicylic acid or other anti-inflammatory drugs such as ibuprofen. Avoid drinking alcohol and caffeine.

The method of treatment will depend on the cause of the abdominal pain.

Abdominal pain can occur with conditions requiring an immediate call to an ambulance. In other cases, emergency medical care is not required - you can examine yourself or contact your local therapist. Additional symptoms and localization of pain will tell you what tests to take and how urgently a doctor's intervention is needed.

Palpation

For intense pain in any part of the abdomen, first place the patient on their back and feel the abdomen. If the surface of the abdomen is hard - almost like a plank - this is a danger sign (protective reflex muscle tension). Another important symptom is if the pain intensifies not when the hand is pressed on the abdomen, but when the pressing hand is abruptly removed from its surface. Both of these symptoms are indicative of an extremely dangerous condition called acute abdomen. It combines internal bleeding, volvulus and peritonitis - inflammation of the peritoneum. All this is a reason for seeking emergency medical help.

If, with abdominal pain, the heartbeat increases, shortness of breath, pallor occurs, profuse sweat appears, or pressure decreases, the doctor should also be called immediately - these are signs of serious bleeding. You should not self-medicate and with repeated vomiting and convulsions.

If the condition is not very serious, you can start examining yourself. You need to start with a general blood test, especially when pain is combined with fever and loose stools. Changes in the number of leukocytes, leukocyte count and erythrocyte sedimentation rate will show whether there is inflammation and whether it is caused by bacteria or viruses. In addition, the KLA can confirm or deny suspicion of appendicitis.

With dull pulling pains on the right under the ribs, the liver is suspected. Additional signs are dark urine and discoloration of feces, nausea, aversion to food. Here, a biochemical blood test for bilirubin and bile pigments, ASAT and ALAT enzymes, alkaline phosphatase is needed.

Pain below the sternum, especially radiating to the left side of the abdomen, is characteristic of diseases of the pancreas. Girdle pain and discomfort in the region of the left scapula are also characteristic. In such a situation, a biochemical blood test for amylase is useful.

Stomach pain can be caused by diseases of the stomach, duodenum and intestines. If a person has had any problems with these organs in the past, it is necessary to undergo EGD and (for the intestines) colonoscopy. They will show gastritis, peptic ulcer disease, neoplasms - especially if a piece of tissue was taken for analysis (biopsy).

EGDS can be accompanied by pH-metry - an assessment of the amount of hydrochloric acid in gastric juice. It changes with inflammation and cancer. The state of motility, i.e., movements of the stomach and intestines, is examined. Sometimes food can "move in the opposite direction" from the intestines to the stomach or from the stomach to the esophagus. In this case, heartburn, belching with bile or the remains of undigested food often occur.

Visualization techniques

The advantage of ultrasound is its harmlessness and low cost. The method allows you to assess the structure and size of organs, the state of their blood supply. In addition, the abbreviation "OBP ultrasound" hides the examination of several organs at once: liver, gallbladder, pancreas and spleen. Indirectly, the condition of the stomach and duodenum will be assessed.

MRI enables detailed examination of the structure of organs. However, some people find it difficult to endure being in closed tomographs, and open-type devices give an image of inferior quality. The disadvantage of CT is the effect on the body of X-rays, and the advantage is the open apparatus and the shorter duration of the study.

Thus, when drawing up a survey plan, it is necessary to follow a general principle - from simple methods to more complex ones. In addition, you need to understand: the most likely "culprits" of abdominal pain are involved in the metabolism. Therefore, if you decide to take tests yourself, then it is best to start with blood tests, which, despite their relatively low cost, are very informative.

Lydia Kulikova

Photo istockphoto.com

Abdominal pain is an unpleasant sensation that can range from mild discomfort to severe and intense pain. It can be either paroxysmal or chronic, acute or dull, aching or cutting.

Causes of abdominal pain can vary widely and include gallbladder disease, stomach ulcers, food poisoning, diverticulitis, appendicitis, cancer, gynecological conditions (eg, fibroids, cysts, infections), and cardiovascular problems. Sometimes women experience abdominal pain during pregnancy.

When determining the causes of abdominal pain, the doctor will be interested in the patient's medical history, conduct a physical examination and offer to take tests (for example, blood and urine tests) and undergo an examination (for example, tomographic, endoscopy, X-ray).

Treatment for abdominal pain depends on the underlying cause and may include under the supervision of a doctor, hospital treatment, and even surgery.

The role of pain for humans is twofold. On the one hand, despite all the discomfort it causes, pain plays an important role in signaling the presence of problems in the body. On the other hand, pain is an integral part of the disease, and severe and intense pain often becomes more dangerous than the condition that caused it. From this point of view, chronic pain caused by damage to nerve fibers is especially unpleasant. Although the very cause of the disease may have been eliminated many years ago, the person continues to suffer from pain. In some especially severe cases, pain can be eliminated only by removing the corresponding parts of the brain responsible for its appearance.

Why exactly the pain occurs is not completely clear. According to some, pain can be perceived by any receptor, and its occurrence depends only on the degree of intensity of the sensation. On the other hand, only special receptors that react to stimuli of special strength take part in the formation of the feeling of pain.

It is believed that abdominal pain can occur due to spasm of smooth muscles, stretching of the walls of internal organs or inflammation. Physicians believe that both pain and spasm of internal organs, as a rule, are caused by one common cause.

The strength of the pain experienced depends on the individual characteristics of the person - some people feel pain more acutely, others tolerate it more easily. The strength of the pain also depends on the emotional background and the environment in which the person suffering from stomach ailments is.

Types of abdominal pain

Determining the type of pain and its location can help the doctor find the cause of the disease. When making a diagnosis, the following factors are usually taken into account:

• How the patient feels pain. Abdominal pain can be sharp, dull, stabbing, deep, squeezing, cutting, burning, and so on.
• How long does the pain last. In the abdomen, pain can last as long as a couple of minutes, or continue for several hours or even more. The very sensation of pain can vary from strong and sharp to mild and aching.
• Does your stomach hurt all the time? Sometimes the pain, which was at first sharp and severe, subsides and resumes over time.
• What exactly is causing the pain? Stomach pain can both relieve and aggravate certain events, such as eating, going to the toilet, vomiting, or taking a certain position (for example, the pain gets worse if the person is lying down).
• How does a person feel after eating certain foods? Is he getting better or worse? For example, if you have stomach ulcers, you may be affected by an orange that you eat, and if you have gallbladder disease, you may have a fatty chop.

What is Acute Stomach Pain?

This is an unexpected, severe and sharp pain, the intensity of which can increase over time. As a rule, it becomes stronger when walking, when a person coughs, sighs, changes body position. If the pain is sharp, the abdominal muscles may tense, which is easily determined by a doctor on examination. Acute pain indicates the possibility of the appearance of diseases that pose a danger to human life, often requiring urgent medical attention, up to hospitalization and surgery. Acute abdominal pain is caused by diseases such as perforation of an ulcer, enetrokolit, inflammation of the intestinal diverticulum, acute cholecystitis, rupture of the spleen, ectopic pregnancy, and so on.

What is Chronic Abdominal Pain?

Unlike acute pain, chronic pain can last for a long time - a week, several months, or even more. The pain is dull, it can sometimes increase, or be almost imperceptible. Its frequent companions are nausea, vomiting, perspiration. Constant abdominal pain is a symptom of functional disorders in the body, such as irritable bowel syndrome, as well as diseases of the digestive tract: reflux esophagitis, colitis, diverticulitis, gastric ulcer and duodenal ulcer and others.

What diseases can cause abdominal pain?

If a person has pain in the abdomen of a aching nature, the likely cause is irritation of the nerve receptors of the mucous membrane of internal organs during inflammation, for example, inflammation of the peritoneum. With periodic pain that occurs at a certain time interval and then disappears, the likely cause is an increased secretion of gastric juice. When the pain is sharp, similar to contractions, it means that the patient has a spasm of the smooth muscles of the hollow organs, for example, the intestines. If the pain is aching and pulling, it may be caused by stretching of the walls of internal organs - for example, with increased gas production. Also, abdominal pain is seasonal, usually worsening in spring or autumn.

What diseases cause abdominal pain in certain places?

To make it easier for the doctor to diagnose, it is customary to divide the abdomen into four parts. If you mentally draw a vertical line from the base of the chest to the pubis, and a horizontal line through the navel from left to right, it turns out that the abdomen is divided into four segments. These are called quadrants (top left, bottom right, bottom left, and top right). Below is a list of diseases associated with specific quadrants.

Upper left quadrant: ruptured spleen, pancreatitis, pneumonia, etc.

Upper right quadrant: gallbladder disease (stones, cholecystitis), hepatitis, pancreatitis, esophagitis, intestinal obstruction, pneumonia, heart failure, and other diseases.

Lower left quadrant: diverticulitis, diseases associated with the female reproductive system (cyst of the left ovary, torsion of the left ovary), irritable bowel syndrome, etc.

Lower right quadrant: uterine disease, inflammation or torsion of the right ovary, cyst of the right ovary, bowel disease, abscess, hernia, etc.

Pain in the upper abdomen: stomach ulcer, gastritis, pancreatitis, functional dyspepsia, malignant tumors, myocardial infarction, etc.

Pain in the middle of the abdomen: kidney disease, colitis, hernia, bowel obstruction, etc.

Pain in the lower abdomen: infections of the ureters, diseases of the uterus (fibroids, cancer), irritable bowel syndrome (especially if accompanied by constipation or diarrhea), diverticulitis, intestinal obstruction, colitis, cystitis, etc.

If pain cannot be localized in any one area of ​​the abdomen, this is a symptom of the possible presence of infectious gastritis and enterocolitis, peritonitis, infections of the ureters and bladder.

It is worth noting that the diagnosis of diseases only by the nature and location of pain sensations cannot be one hundred percent correct. A person may have a stomach ache in one quadrant, although in fact the disease struck an internal organ located in a completely different place. Moreover, the cause of abdominal pain may not be in the abdominal region at all - for example, in some diseases, including pneumonia, pain can be projected into the abdomen.

Often a feeling of abdominal pain occurs with heart and lung diseases (coronary heart disease, pericarditis, pneumonia and pulmonary embolism). Diseases of the internal organs located in the pelvic region can cause abdominal pain, like testicular torsion in men. Shingles can also cause abdominal pain, although there may be no malfunctioning of the internal organs in this area.

Poisoning, bites of poisonous animals or insects also sometimes cause abdominal pain.

Symptoms accompanying abdominal pain

By itself, abdominal pain is already a symptom - it means that a person is sick, and treatment is needed. It may be accompanied by other phenomena, for example, high fever, chills, perspiration, bleeding. It is recommended to pay special attention to the conditions when severe pain occurs, whether it is combined with eating and whether abdominal pain occurs when a person suffers from diarrhea.

Causes of abdominal pain

Many acute (short-term) and chronic (long-term) illnesses cause abdominal pain. Most people believe that abdominal pain can be associated with gastritis, appendicitis, kidney stones, gallbladder disease, gastric and duodenal ulcers, infections, and pregnancy. All of these conditions are common and well known. However, abdominal pain can also be caused by more rare conditions, such as ruptured blood vessels, visceral vein thrombosis, inflammation of the liver and pancreas, circulatory problems in the intestine, cancer, and other conditions.

Abdominal pain during pregnancy

In the absence of other symptoms, the heaviness in the abdomen and pelvic area is not yet a reason for worry. Women in the first trimester often feel it. This phenomenon is associated with increased blood circulation, growth of the uterus, at a later date - with the ever increasing weight of the child. The pelvic floor muscles stretch, the uterus presses on the bladder and rectum, which can cause pain in the abdomen.

But if the feeling of heaviness is accompanied by pain, cramps, vaginal discharge (bloody or watery) appears, you should immediately consult a doctor. These symptoms may indicate a miscarriage, an ectopic pregnancy, or (at a later date) the onset of premature labor.

The second reason for the appearance of abdominal pain during pregnancy is the so-called. diastasis, when, under the influence of the pressure of the growing uterus, the abdominal muscles can disperse. This is usually painless, but some women may experience pain in the navel or back. Medical attention is not required for this condition; usually after childbirth, everything returns to normal.

When to seek medical attention for abdominal pain

You should immediately go to the doctor if the patient observes the following symptoms:

• If the abdominal pain lasts more than six hours in a row and / or gets worse.
• For any acute abdominal pain.
• When abdominal pain occurs after eating.
• If the pain is so strong that the person is unable to eat.
• When, with pain in the abdomen, a person vomits three to four or more times in a row.
• For abdominal pain during pregnancy.
• If the pain increases when the person tries to change the position of the body.
• When pain is first felt near the navel, and then it shifts to one place, especially to the lower right quadrant. This could be a sign of appendicitis.
• If a person wakes up at night in pain.
• When abdominal pain is accompanied by bleeding from the vagina during pregnancy. A doctor should be consulted even if the woman does not think she is pregnant.
• For abdominal pain accompanied by high fever.
• If the person has pain when urinating, passing a bowel movement, or trying to pass gas.
• For any pain other than a simple feeling of stomach discomfort.

Emergency medical care for abdominal pain

• When the pain is so strong that the person experiencing it loses consciousness, suffocates. This condition is characteristic of abdominal bleeding, perforation of the intestinal or stomach wall, acute pancreatitis, and liver failure.
• In acute pain, when a person is unable to move.
• If abdominal pain is accompanied by vomiting of blood or vomiting lasts more than several hours.
• When acute abdominal pain is accompanied by a complete lack of bowel activity for several days (this may indicate an obstruction of the digestive tract).
• If abdominal pain is accompanied by bleeding from the rectum. With acute pain, intestinal ischemia or bleeding into it (for example, with a ruptured abdominal aorta), ulcer perforation, or hemorrhagic gastropathy are likely. If the pain is chronic, then bleeding, coupled with abdominal pain, may indicate cancer.
• If a person experiences chest and abdominal pain, but is not sure exactly where exactly (it can serve as an indicator of heart disease).
• In men, if there is pain in the groin area (testicular torsion; if it is not adjusted, tissue necrosis may begin after a few hours).

Which doctor is best for abdominal pain

The doctor's specialization depends on the cause of the pain. It is preferable to start with a general practitioner who will conduct a preliminary diagnosis and, based on its results, will refer you to a specialist doctor. Depending on the final diagnosis, it will be a therapist (trauma, bruises), surgeon (appendicitis, ovarian torsion), gastroenterologist (stomach ulcer or duodenal ulcer), nephrologist (kidney stones) or gynecologist (fibroids). If the pain is severe, the patient may end up in a specialized department in a hospital.

Diagnosis of abdominal diseases

Determining the cause of abdominal pain is one of the most difficult tasks for a doctor. Sometimes it happens that the only thing that remains for a qualified specialist is to exclude the need for surgery or hospitalization. Sometimes no specific cause of pain can be found, and it gradually goes away on its own.

During the examination, the doctor may ask many questions, some of which may not be directly related to the current condition of the patient. Nevertheless, it is important to try to give the fullest possible answer to them - this way the doctor will quickly find the cause of the disease.

Questions can be as follows:

• How long have you been in pain?
• What were you doing when you felt pain?
• How did you feel before the pain started?
• How have you been feeling over the past few days?
• What have you tried to do to ease the pain? Did these actions help?
• What causes the pain to intensify? What weakens it?
• Where is the pain focus? Right, left, top, bottom?
• Does the pain decrease or, conversely, increase if you stand in one place?
• And if you move?
• How did you get to the hospital? Did you experience pain while traveling by public transport or in a car?
• Does the pain increase when coughing?
• Are you sick? Was there vomiting?
• Does vomiting cause worsening or improvement?
• Was your intestines functioning normally?
• When was the last time you visited the toilet?
• Do you manage to release gases?
• Do you have a high temperature?
• Have you experienced the same pain before?
• When exactly? Under what conditions did it arise?
• Have you had an exacerbation of pain during your period?
• Did you have an operation, what kind and when was it done?
• You are pregnant? Are you sexually active? Are you using contraception?
• Have you recently been around someone with similar symptoms?
• Have you traveled outside the country in the near past?
• When was the last time you ate? What exactly did you eat?
• Have you eaten any food that is different from your usual diet?
• Was it such that at first the stomach ached in the navel area, and then the pain moved to some other place? If so, what time?
• Does the pain give to the chest? In the back? Somewhere else?
• Can you close the area of ​​pain with your palm, or is it larger?
• Does it hurt to breathe?
• Do you suffer from diseases such as heart disease or diabetes?
• Are you taking pain relievers, steroids, aspirin?
• Are you taking antibiotics? Over-the-counter drugs? Supplements? Medicinal herbs?
• Do you smoke?
• Do you drink alcohol? How often do you drink coffee? Tea?

Of course, the doctor is unlikely to force the patient to answer all questions at once, without exception. But depending on the symptoms, additional questions may be asked.

Medical examination for abdominal pain

Medical examination consists in assessing the general condition of the patient, movements, skin color, activity, breathing pattern, posture taken by him, and so on. Then the doctor usually asks the patient to expose the abdomen and chest and will perform palpation and percussion, that is, he will touch and tap different parts of the abdomen to check the degree of tension and other signs indicating abdominal disease. In addition to the abdomen, the doctor must also listen to the patient's lungs and heart.

The doctor may do a rectal exam to determine if there is blood in the rectum or other conditions, such as hemorrhoids.

If the patient is male, the doctor may examine the penis and testicles. If the patient is a woman, the doctor may examine the pelvic area to determine if the cause of the pain is related to the uterus, fallopian tubes, and ovaries.

Also, the doctor can check the color of the whites of the patient's eyes (if they have turned yellow), as well as the oral cavity (if it is dry, if dehydration has begun).

Tests for abdominal pain

Based on the results of the information received from the patient, the doctor may offer to do blood, urine and feces tests, as well as conduct an ultrasound of the abdominal cavity. If the patient is a woman, she will be advised to take a pregnancy test.

Blood test

The blood will be checked for morphology, levels of electrolytes, glucose, creatinine. If after the first analysis it was not possible to make a diagnosis, a biochemical analysis may follow with a check for the level of amylase, bilirubin, etc. An increased level of leukocytes may indicate the presence of an infection in the body or be simply a reaction to stress and pain. A low level of red blood cells (hemoglobin) may indicate internal bleeding; however, usually most of the bleeding does not cause abdominal pain. A biochemical blood test for liver and pancreatic enzymes will help determine which organ is out of order and can cause a feeling of pain in the abdomen.

Analysis of urine

A urinary infection is one of the most common causes of abdominal pain. The presence of an infection can be determined already by visual examination of the urine analysis - if it is cloudy, smells strong and unpleasant, then the presence of an infection is more than likely. Blood in the urine that is not visible on visual inspection may indicate kidney stones. Microscopic examination of the sediment will show if the urine contains protein, sugar, ketone bodies, etc.

Tests for abdominal pain

If the cause of the abdominal pain is clear already during the initial medical examination, additional examinations are not required. But when it is not immediately possible to make a diagnosis, the doctor may suggest that the patient conduct the following studies.

Gastroscopy

If you suspect damage to the mucous membrane of the esophagus, stomach and duodenum, your doctor may advise you to do a gastroscopy. The patient swallows a long tube with a tiny video camera at the end, with which the doctor can examine the condition of the surface of the patient's digestive tract. Gastroscopy is indispensable for suspected gastric ulcer and duodenal ulcer. In addition to examining, the doctor can use an endoscope to biopsy and determine the acidity level and microbial contamination of the lining of the stomach.

Colonoscopy

By its principle, colonoscopy is very similar to gastroscopy, only the endoscope is now used to examine the condition of the inner surface of the large intestine and rectum.

Biopsy

A biopsy takes a sample of the tissue lining the inside of your digestive tract and examines it under a microscope. A biopsy is indispensable if you want to find out whether it is a benign tumor or not, and whether pathological changes have occurred in the epithelium of the mucous membrane of internal organs.

Medical radiological examinations

In some cases, the doctor may offer to conduct a series of radiological examinations to the patient.

X-ray

Usually, for acute abdominal pain, the patient is asked to take an X-ray of the chest in a standing position. On it you can see the condition of the organs of the chest cavity, diseases of which can cause pain in the abdomen, as well as the presence of air under the diaphragm.

In some cases, the patient is given an X-ray of the abdomen while standing and lying on his back. X-rays can reveal accumulations of air outside the intestines, which may indicate a rupture or perforation. The lack of air in some parts of the intestine may be a sign of intestinal obstruction. Also, the image can determine the presence of gallstones and urinary stones and large formations in the abdominal cavity.

Ultrasound

Ultrasound examination is a painless and safe procedure. The doctor may prescribe it if he believes that the cause of the pain lies in abdominal diseases - problems with the gallbladder, pancreas, liver or female reproductive system. Also, ultrasound examination helps to diagnose diseases of the kidneys, spleen, large blood vessels that supply blood from the heart to the lower part of the body, and in the case of a mass in the abdominal cavity, its nature.

Computed tomography (CT)

This method is used to examine the condition of the liver, pancreas, kidneys, ureters, spleen, and small and large intestines. CT can also help detect inflammation in the abdominal cavity.

MRI

Magnetic resonance imaging is usually less useful for examining the abdomen than computed tomography, but a doctor may prescribe it for certain symptoms.

Angiography

Angiography is a method of examining blood vessels in which a radiopaque contrast agent (usually an iodine preparation) is injected into the patient's body. It allows you to detect the presence of blood clots and embolism in the arteries.

Irrigoscopy

An analogue of angiography is irrigoscopy, when a radiopaque contrast agent is injected into the colon. It allows you to determine the presence of intestinal obstruction and its cause, as well as the presence of intestinal perforation.

Cholescintigraphy

It is carried out with suspicion of acute cholecystitis, impaired patency of the bile duct and other diseases of the biliary tract.

Treating abdominal pain

Treatment depends on the diagnosis and can range from simple medication and diet to surgery under general anesthesia.

The doctor may prescribe pain relievers to the patient. If the pain is caused by a spasm in the intestines, the doctor may inject the pain reliever into the patient's thigh, leg, or arm. If there is no vomiting, then the patient is able to take pain relievers in combination with an antacid drug or separately.

Is surgery required to treat abdominal pain?

It happens that abdominal pain is caused by diseases or conditions that require surgery (for example, inflammation of the appendix or gallbladder). In this case, the patient will be sent to the hospital, where he will undergo surgery.

Sometimes an intestinal obstruction also requires surgical intervention. The need for surgery is due to the severity of the patient's condition and the ability to remove the obstacle in a non-surgical way. If the abdominal pain is caused by a rupture or perforation of an internal organ such as the stomach or intestines, the patient needs immediate surgery.

Should I see a doctor after the abdominal pain stops?

If the reasons that caused the soreness of the abdomen do not require inpatient treatment, the doctor explains to the patient what medications he should take, how to eat, what to abstain from, which regimen to follow. If, with all the conditions of treatment, pain continues or recurs, you should make an appointment for a second appointment.

You also need to see a doctor immediately in one of the following cases:

• Severe abdominal pain, which only increases in intensity over time
• Heat
• Inability to urinate or have a bowel movement
• Or for any other symptom that makes the patient anxious.

How to relieve stomach pain at home?

Abdominal pain, not complicated by fever, vomiting, rectal and vaginal bleeding, fainting, or other symptoms of serious illness, often goes away on its own without medication.

A warming compress, an abdominal heating pad, or a hot bath can help relieve abdominal pain at home. Antacids that can be bought without a prescription (for example, Almagel, Fosfalugel, Maalox) can also reduce pain if the patient is sure that it is associated with diseases of the digestive system. Also, for pain caused by food poisoning or overdose of certain medications, activated charcoal tablets may help.

You should avoid taking aspirin or ibuprofen - if the cause of the pain is gastric ulcer and duodenal ulcer or liver disease, both of these drugs will irritate the mucous membrane and will only worsen the pain.

If the cause of the pain is gas accumulated in the intestines, you can lie on your back, press your knees against your stomach and swing slightly back and forth. Thus, the pressure on the abdominal area is reduced, the muscles relax and gas separation is less painful.

Muscle tension in the abdomen can be relieved with massage. Hands should be moved slowly, smoothly and either clockwise or up and down. Combining the massage with deep, measured breathing can help relieve pain.

What to eat for abdominal pain?

One of the key features of chronic abdominal pain treatment is diet. As a rule, with diseases of the stomach, intestines, gallbladder, the doctor tells in detail what kind of diet the patient needs. If detailed instructions are not followed, you can adhere to the following diet.

If the patient's appetite has woken up, it is worth starting with liquids - broth, very thin soups, and so on. If the patient's stomach accepts them, you can gradually introduce new foods into the diet, such as white bread croutons, rice without salt, bananas and baked apples. If the dynamics of recovery is positive within a few days, you can return to your usual diet.

Can abdominal pain be prevented?

If the doctor made a diagnosis, the cause of the pain was identified and the disease was named, in some cases the patient is required to adhere to the regimen. For example, in case of gastric ulcer and duodenal ulcer, one should refrain from drinking alcohol, coffee and reduce smoking to a minimum or quit altogether. And with diseases of the gallbladder, you should avoid fatty and fried foods.

What is the prognosis for abdominal pain?

In general, many diseases that cause abdominal pain go away without hospital treatment or surgery. Often, the person only needs to relieve the symptoms.

As a rule, if the disease is mild or moderate, the prognosis is favorable (with some exceptions). And if the disease is more severe and requires surgical intervention, the prognosis depends on both the severity of the disease and the general condition of the person. For example, if the cause of abdominal pain is uncomplicated appendicitis or gallbladder stones, people tend to recover quickly from surgery and make a full recovery. If the appendix is ​​ruptured and the gallbladder is inflamed, recovery can take much longer. And if an ulcer or intestinal obstruction perforates, it will take even longer. In general, the older the person is, the longer it takes to recover.

Abdominal pain is the most common complaint in both children and adults. Their causes are diverse, ranging from simple indigestion or diseases of the digestive tract, worms, appendicitis to pneumonia, kidney or bladder inflammation, infectious diseases (even tonsillitis and SARS), however, it is important to distinguish when pain is a consequence of intestinal hyperperistalsis, for example, with excessive gas formation, and when - a serious symptom of a pathological process. Usually, abdominal pain that lasts from a few seconds to a minute is not a major cause for concern.

There are two main types of pain - visceral and somatic. Visceral pain occurs due to irritation of nerve endings in the wall of organs, these are pains associated with spasm or, conversely, with stretching, for example, of the stomach or duodenum (and sometimes with ischemia of their mucous membrane). Visceral pain occurs as colic(hepatic, renal, intestinal, etc.) of varying intensity, diffuse diffuse, dull in nature, localized not only in the area of ​​the affected organ (often along the midline of the abdomen), but also in other parts of the abdomen, has a certain irradiation - reflected transmission of pain into the parts of the body, innervated from the same roots, in which sensitive fibers pass, carrying impulses from the corresponding internal organs.

Somatic (peritoneal) pain occurs due to irritation of the peritoneum, when, with the development of a pathological process (for example, with perforation of a stomach ulcer), the endings of the spinal nerves located in the peritoneum begin to irritate.

Somatic pain, in contrast to visceral pain, has a constant character, precise localization, is accompanied, as a rule, by tension of the muscles of the anterior abdominal wall, has an acute cutting character, increases with movement and breathing. Patients lie motionless in bed, as any changes in position increase the pain.

Cramping pains usually indicate a limited narrowing of the intestine as a result of various pathological processes (cicatricial strictures in ulcerative colitis and Crohn's disease of the colon, adhesive disease, benign and malignant tumors). Less commonly, they are noted with intestinal dyskinesia with a predominance of the spastic component.

Constant abdominal pain more characteristic of progressive inflammatory lesions, they are observed in granulomatous and nonspecific ulcerative colitis, irritable bowel syndrome, intestinal tumor with perifocal inflammation, diverticulosis with diverticulitis and the formation of inflammatory infiltrate or the development of peritonitis. Dull pain in the epigastric region is often the first manifestation of diffuse familial colon polyposis and can be explained by a violation of the secretory and motor activity of the stomach.

Possible Causes of Stomach Pain

The most common cause is the food we eat. Irritation of the esophagus (pressing pain) is caused by salty, too hot or cold food. Certain foods (fatty, cholesterol-rich foods) stimulate the formation or movement of gallstones, causing bouts of biliary colic. Some people have an intolerance to certain types of foods, such as milk, milk sugar, or lactose. Eating them leads to abdominal cramping, bloating and diarrhea.

Depression, spinal disease, thyroid disease, anemia, and urinary tract infections can be accompanied by abdominal pain. The reason may be the intake of alcohol, drugs, antibiotics, hormonal and non-hormonal anti-inflammatory drugs, iron preparations.

The main groups of diseases and pathological conditions leading to abdominal pain:

• diseases (organic, functional) of the organs of the abdominal cavity, stomach and duodenum, liver and biliary tract, pancreas, intestines, spleen;
• food toxicoinfections, intoxication;
• diseases and inflammation of the peritoneum;
• diseases of the kidneys and urinary tract;
• local circulatory disorders in the abdominal cavity (mainly arterial);
• diseases and damage to the abdominal wall;
• some diseases of the nervous system, spinal column (Herpes Zoster, spondyloarthrosis);
• some diseases of the blood system (hemorrhagic vasculitis, thrombophlebic splenomegaly);
• diffuse connective tissue diseases (periarteritis nodosa), rheumatism;
• pathological processes in the chest (pneumonia, diaphragmatic pleurisy, pericarditis, acute coronary insufficiency);
• abdominal pain in certain, including rare diseases, pathological conditions (abdominal colic in some types of hyperlipoproteinemia, diabetes mellitus, thyrotoxicosis, diseases of the nervous system, etc.).
• in children, abdominal pain can occur with infectious diseases that are not directly related to the abdominal cavity, for example, with angina, ARVI, scarlet fever.

And one of the rarest, but worst treatable causes of abdominal pain is malignant neoplasm, that is, cancer. When examined, first of all, it is necessary to be categorically thoroughly examined for oncology. There were cases when patients were treated for gastritis for a year, and it turned out to be stomach cancer, and already 3-4 stages.

Localization of abdominal pain

Diagnosis of pain in the epigastric region is one of the most difficult and responsible tasks in medicine. Due to the urgency of the situation, the usual systematic examination of the patient is often impossible. The clinical experience of the doctor is of great importance here, since sometimes in the most acute, life-threatening conditions, the picture of the disease is erased. With the most vivid picture of the "acute abdomen", surgical treatment may not be necessary, and, on the contrary, mild pain may be the first sign of a disease in which an urgent operation is indicated. Be that as it may, for any acute, unusual abdominal pain, a comprehensive examination is necessary.

In classical cases, there is a correspondence between the localization of pain and the affected organ.

The pain is localized below the waist (lower abdomen):
Have men possible diseases of the urinary system; observe urination and urine;
Have women possible diseases of the urinary system, pregnancy, painful menstruation, inflammation of the internal genital organs.

Pain above the pubis (lower abdomen, "lower abdomen hurts") in women- pathological processes in the bladder, uterus and appendages, may indicate the occurrence of problems with the reproductive system. Pelvic pain that occurs every month before menstruation may indicate endometriosis, a condition in which tissue particles from the uterus move through the fallopian tubes and enter the ovaries, pelvis, bladder, and other organs. Soreness in the lower abdomen may indicate pelvic inflammation (infection of the tissues of the uterus, fallopian tubes, or ovaries). In women of childbearing age, an ectopic pregnancy can also cause sharp, sharp or stabbing pain in the peritoneum, accompanied by vaginal bleeding, an irregular menstrual cycle, and pain radiating to the shoulders. Ovarian cysts and uterine fibroids can also cause abdominal pain in women. ...

The pain is localized in the projection of the stomach with diseases of the esophagus, stomach, duodenum. However, with myocardial infarction, pneumonia and pyelonephritis, there may be a similar localization: if the stomach hurts, doctors think not only about digestive problems.

Soreness in the umbilical region- for diseases of the small intestine.

Pain in the right iliac region (near the wing of the ilium on the right)- the cecum and appendix. In the left iliac region- the sigmoid colon.

Abdominal pain started in the lower back and moved to the groin: possible pathology of the urinary system, urolithiasis.

Pain in the abdomen spreads in the area of ​​the right hypochondrium (in the abdomen on the right, it can give under the right scapula): pathology of the liver, biliary tract or gallbladder is possible; observe skin color, urine and stool color.

Acute pain in the right hypochondrium, worsening after eating, indicates the presence of a lesion of the gallbladder. Diseases of the gallbladder include stones and inflammation of the gallbladder (cholecystitis). If complications arise, damage to the gallbladder may have other symptoms, these include: jaundice (yellowing of the skin and whites of the eyes), severe fever and chills. Sometimes people with gallstones experience no symptoms at all. If pain occurs regularly in the right hypochondrium, you should consult a doctor. Gallbladder pain attacks can be managed in a number of ways, from simply waiting (observing symptoms for a while, not receiving any treatment) to taking medications and even surgery. You can also reduce the symptoms of gallbladder disease by reducing the amount of fat in your diet.

Pain more often localized in the left hypochondrium (in the abdomen on the left) with pancreatitis. Pain in ulcers and pancreatitis, as a rule, radiates through the entire back.

In the center of the upper abdomen:
It may be heart pain (extending up the chest and even into the arms);
Digestive disorders as a result of overeating, emotional or physical overstrain are not excluded.

Above the waist:
Possible digestive disorders in the stomach (gastritis) or duodenum.

Below the navel:
With swelling and a feeling of discomfort in the groin, which increases with physical exertion or coughing, a hernia is not excluded (it can only be treated by a doctor);
Possible constipation or diarrhea;
In women with genital dysfunction (watch for vaginal discharge) or pregnancy.

Pelvic pain is usually felt as pressure and discomfort in the rectal area.

Abdominal pain that is relieved by a bowel movement and is accompanied by diarrhea or constipation, may indicate irritable bowel syndrome, a common disorder of the gastrointestinal tract, the cause of which has not yet been established. When irritable bowel syndrome occurs, the walls of the intestines are compressed sometimes too much, sometimes too weakly, sometimes too slowly, and sometimes, on the contrary, too quickly. Symptoms of this disease include: bloating, increased gas production, slimy stools, a constant desire to empty the intestines. This syndrome cannot be dealt with with surgical methods or medications. However, worsening of the condition can be prevented by drinking plenty of water, increasing the amount of fiber in the diet, reducing the amount of caffeine consumed, and increasing exercise.

Pain in the lower left abdomen can be a symptom of diverticulitis. Diverticulitis occurs when small, spherical capsules called diverticula form in the walls of the colon, which subsequently become infected and inflamed. Other symptoms of diverticulitis include fever, nausea, vomiting, chills, seizures, and constipation. Treatment for diverticulitis usually involves clearing the colon of infections and inflammation. The doctor may prescribe antibiotics and / or pain relievers, a liquid diet, and bed rest for several days. In some cases, treatment for diverticulitis requires a hospital stay. If complications arise, surgery may be necessary. The best way to prevent diverticulitis is a diet rich in fiber. Dietary fiber promotes proper digestion and relieves pressure in the colon. Gradually increase the amount of fiber in your daily diet and drink plenty of fluids. Timely bowel movements can also help prevent diverticulitis. The accumulation of waste products from the digestive system causes an increase in pressure in the colon.

Acute burning pain in the upper and middle parts of the abdomen (between the sternum and the navel) may indicate the presence of an ulcer. An ulcer is a wound that forms in the tissues of the stomach or upper intestine. There are many causes of ulcers. Smoking, acetylsalicylic acid, ibuprofen, or other nonsteroidal anti-inflammatory drugs (NSAIDs) may play a role. An ulcer can also form if the stomach cannot protect itself from strong stomach acid. Helicobacter pylori, a bacteria that lives in the stomach, can also cause ulcers. Stress and spicy foods cannot cause ulcers. Heartburn alone cannot indicate this disease. Severe soreness like heartburn can also be caused by a less serious condition called gastroesophageal reflux disease.

Dagger abdominal pain- a dangerous sign. It can be a manifestation of a catastrophe in the abdominal cavity - acute appendicitis or peritonitis (inflammation of the peritoneum). An urgent need to call an ambulance! Do not give the patient any medication before she arrives.

The abdomen hurts constantly, the pain is sharp or growing- It is necessary to consult a gastroenterologist who will determine the examination tactics.

Attention!
Signs such as persistent abdominal pains that do not subside within 2 hours, soreness of the abdomen when touched, the addition of vomiting, diarrhea, increased body temperature should seriously alert. If abdominal pain is accompanied by dizziness, weakness, decreased blood pressure, increased heart rate, visible bleeding, fever, repeated vomiting, increased intensity, fainting, muscle tension of the abdominal wall, then urgent diagnostic measures, intensive observation, and a decision on the expediency of surgical intervention are necessary.

What to do, where to go for abdominal pain

Pain in the abdomen cannot be relieved with pain relievers. A heating pad should not be used unless the cause is known. You can apply ice. First of all, if you experience pain in the abdomen, you should contact at least a therapist. If necessary, the doctor will prescribe an endoscopic examination, which allows you to visually monitor the examined organ and record the examination.

First aid for abdominal pain

In case of painful sensations in the abdomen, especially strongly pronounced, do not self-medicate, in no case do not take painkillers before the diagnosis is made!

By eliminating the pain, lowering the temperature (and many painkillers effectively reduce the temperature), you make it difficult for doctors to make a diagnosis, and this can lead to serious complications. Remember that abdominal pain in almost all cases is a rather serious phenomenon that cannot be treated indifferently, because it is in the abdomen that the most important human organs are located. Problems of the heart, digestive and endocrine systems, and the reproductive system can manifest as abdominal pain. Therefore, they should not be taken lightly.

The following diseases require urgent medical attention.

Abdominal pain on the right - suspected acute appendicitis

Acute appendicitis - inflammation of the appendix of the cecum; an extremely dangerous disease requiring surgical intervention.

Signs of appendicitis

Abdominal pains appear suddenly, usually in the umbilical region, then cover the entire abdomen and only after a few hours are localized in a certain place, often in the lower right abdomen. The pain is constant, aching and is rarely severe in young children.

The body temperature rises. There may be nausea and vomiting.
If the inflamed appendix is ​​high (under the liver), then the pain is localized in the right upper abdomen.
If the inflamed vermiform appendix is ​​located behind the cecum, then the pain is localized in the right lumbar region or "spreads" throughout the abdomen.
If the inflamed appendix is ​​in the pelvis, then signs of inflammation of neighboring organs join the pain in the right iliac region: cystitis (inflammation of the bladder), right-sided adnexitis (inflammation of the right uterine appendages).
An unexpected cessation of pain should not soothe, as it may be associated with perforation - a rupture of the inflamed intestine wall.
Make the person cough and see if it causes severe abdominal pain.

Acute appendicitis is the most common acute abdominal disease requiring surgery. The disease begins suddenly, with the appearance of pain in the epigastric region or throughout the abdomen, sometimes near the navel, which gradually increases. After some time, they are localized in the right half of the abdomen, the right iliac region (near the wing of the ilium on the right). A slight rise in temperature, increased heart rate, dry tongue. When pressing on the abdomen, a sharp soreness is determined in the right half of the abdomen, the right iliac region, which increases when the hand is released, muscle tension.

Features of the clinical manifestations of acute appendicitis in children associated with the structural features of the appendix. Children of the first years of life become restless, refuse food, cry, and in case of severe pain, they scream. The tongue is dryish, the temperature is up to 38-39 ° C, the pulse is speeded up. The abdomen is painful in the right half. It is necessary to call your local pediatrician or ambulance. Elderly and senile people have the same signs of appendicitis, but they are poorly expressed due to the decreased reactivity of the body, atherosclerosis and the rapidity of development of changes in the appendix.

Help

You can put a plastic ice bag on your stomach.

Pain in the hernia is a sign of a strangulated abdominal hernia

Infringement of a hernia of the abdominal cavity (inguinal, femoral, umbilical, postoperative, etc.) is accompanied by the following symptoms:
acute pain in the hernia (can only be in the abdomen)
enlargement and compaction of hernial protrusion
soreness when feeling.

Often the skin over the hernia is bluish in color; the hernia does not adjust itself into the abdominal cavity. When the loop of the jejunum is pinched in the hernial sac, intestinal obstruction develops with nausea and vomiting.

Hernias are divided into congenital (immediately after childbirth), acquired, which occur in the “weakest” points of the abdomen (inguinal hernia, umbilical ring, femoral hernias, etc.) and incisional hernias (after previously performed operations in the area of ​​the scar). Predisposing factors include an increase in intra-abdominal pressure, hard physical labor, frequent crying and crying of a child, difficult childbirth, cough with chronic lung diseases, constipation, etc.

Depending on the localization of the hernia (in the groin, in the area of ​​the navel, postoperative scar), when it is infringed, severe abdominal pain, nausea, vomiting, stool and gas retention, pulse quickens. In the area of ​​the hernia, simultaneously with pain, a dense formation of a round or oblong shape is determined, sharply painful, not reduced into the abdominal cavity: this differs from a restrained hernia from a reduced one.

Help

Do not try to set the hernia into the abdominal cavity, as you can damage the restrained intestine!
The patient is forbidden to take painkillers, eat and drink!
Urgently call an ambulance (tel. 03) for hospitalization of the patient in a surgical hospital. Delay in calling an ambulance is fraught with dangers and can lead to necrosis (necrosis) of the strangulated intestine.

Acute pain in the upper abdomen - a perforated ulcer of the stomach, duodenum is possible

With exacerbations of gastric ulcer or duodenal ulcer, a life-threatening complication may unexpectedly develop - ulcer perforation (ulcer rupture, in which the contents of the stomach or duodenum are poured into the abdominal cavity).

Signs

Pain for this disease is a cardinal symptom, it arises suddenly, “as from a blow to the stomach with a dagger,” it is very intense, constant. In the initial stage of the disease (up to 6 hours), the patient feels sharp "dagger" pain in the upper abdomen, under the stomach. The patient takes a forced position (legs are brought to the stomach), seeks to restrict respiratory movements .. The skin turns pale, cold sweat appears, breathing becomes shallow. The abdomen does not participate in the act of breathing, its muscles are tense, and the pulse may slow down. In the first hours, the pain is localized in the epigastric region, right hypochondrium. With a free, uncovered perforation, it quickly spreads to the entire abdomen. Possible irradiation of pain in the back, right shoulder, scapula or subclavian region. Less often, the pain radiates to the left. The second most important sign of perforation is a sharp tension in the muscles of the anterior abdominal wall. As a result, the abdomen becomes “hard as a board”, retracted.

In the second stage of the disease (after 6 hours), abdominal pain decreases, the tension of the abdominal muscles decreases, signs of peritonitis(inflammation of the peritoneum):
fast pulse;
increased body temperature;
dryness of the tongue;
bloating;
stool and gas retention.

In the third stage of the disease (10-14 hours after perforation), the clinical picture of peritonitis increases. It is much more difficult to treat patients at this stage of the disease.

Help

Provide the patient with rest and bed rest.
A patient with a suspicion of a perforated ulcer is prohibited from taking painkillers, eating or drinking!
Call an ambulance urgently (tel. 03).

Abdominal pain accompanied by bloody stools or vomiting - a sign of gastrointestinal bleeding

Gastrointestinal bleeding - bleeding from the esophagus, stomach, upper jejunum, colon into the lumen of the gastrointestinal tract.

Gastrointestinal bleeding occurs with diseases:
liver (from the veins of the esophagus);
stomach ulcer;
erosive gastritis;
stomach cancer in the last stage;
duodenal ulcer;
ulcerative colitis (colon disease);
hemorrhoids of the rectum;
other diseases of the gastrointestinal tract (infectious diseases, diathesis, trauma).

Signs

The onset of the disease is usually acute.
With bleeding from the upper gastrointestinal tract (stomach, veins of the esophagus), there is bloody vomiting - fresh blood or blood of the color of "coffee grounds".

The rest of the blood, passing through the intestines, is excreted during bowel movements (feces) in the form of tarry stools (liquid or semi-liquid feces of black color with a pungent odor).
With bleeding from the duodenum with peptic ulcer disease, bloody vomiting is less common than with bleeding from the esophagus or stomach. In this case, blood, passing through the intestines, is released during bowel movements in the form of tarry stools.
With bleeding from the colon, the appearance of the blood changes slightly.
Hemorrhoidal veins of the rectum bleed with scarlet blood (with hemorrhoids).
With gastrointestinal bleeding, general weakness, a frequent and weak pulse, a decrease in blood pressure, profuse cold sweat, pallor of the skin, dizziness, and fainting are observed.
With severe bleeding, a sharp drop in blood pressure.

Help

Place an ice or cold water bubble on your stomach.
In case of fainting, bring a cotton swab moistened with ammonia to the patient's nose.
Do not water or feed the patient!
Do not wash your stomach or give enemas!
Call an ambulance (tel. 03).

Girdle pain in the epigastric region, radiating to the shoulders and shoulder blades - Acute pancreatitis (inflammation of the pancreas):

Signs resemble acute appendicitis, but pain can be severe. In a typical case, the patient complains of constant pain in the epigastric region, which, unlike acute appendicitis, radiates to the shoulders, shoulder blades and has a shingles in nature. The pain is accompanied by nausea and vomiting. The patient usually lies motionless on his side. The abdomen is distended and tense. Jaundice is possible.

The development of acute pancreatitis is facilitated by the pathology of the liver, biliary tract and other digestive organs, alimentary disorders, alcohol abuse, severe vascular lesions, allergic conditions, injuries, operations.

Pain in the abdomen is initially localized in the epigastrium (middle upper abdomen), in the right or, more often, the left hypochondrium, radiates to the left scapula, to the region of the heart. In almost half of the cases, it is shingles. The pain is long lasting, very painful, boring, constricting. Sometimes the pain subsides periodically, but does not completely stop. In severe cases, the pain extends to the entire abdomen. Vomiting, often indomitable, does not bring relief to the pain. The icterus of the sclera is sometimes noted.

Help

Urgently call an ambulance (tel 03).
Do not give the sick person any medication.
You can put a plastic ice bag on your stomach.

Pain and a feeling of heaviness in the pit of the stomach - Acute gastritis (inflammation of the stomach):

this disease is characterized by pain and a feeling of heaviness in the epigastric region of the abdomen ("in the stomach") after eating. Other symptoms are nausea, vomiting, loss of appetite, and belching.

Help

With the development of these symptoms, it is necessary to call a doctor at home or go to the clinic.

Abdominal pain in the upper right - hepatic colic is possible

Hepatic colic is usually caused by stones in the gallbladder or bile ducts that prevent the free flow of bile from the liver and gallbladder. Most often, hepatic colic is caused by improper nutrition (eating meat, fatty and spicy foods, spices in large quantities), excessive physical exertion, and shaking driving.

An attack of hepatic (biliary) colic occurs as a result of a stone pinching in the neck of the gallbladder, in the ducts with gallstone disease or when an infection penetrates the gallbladder and the development of acute non-calculous cholecystitis. An attack of biliary colic is provoked by errors in diet, physical and nervous tension.

Suddenly there is a very sharp, often rapidly growing pain in the right hypochondrium, epigastric region with irradiation to the right shoulder, clavicle, scapula, right side of the base of the neck, rarely to the left side, iliac region, lower back. The pain intensifies in the position on the left side, with a deep breath. An attack of intense pain can last from several hours to several days. During an attack, patients are restless, constantly changing their position. The pain is accompanied by nausea, vomiting of bile, which does not bring relief, sometimes icterus of the sclera, fever, neutrophilic leukocytosis.

Signs

In the right hypochondrium there is a sharp acute paroxysmal pain, often radiating to the right half of the back, the right shoulder blade, to other parts of the abdomen.
Vomiting does not bring relief. The duration of the pain is from several minutes to several hours (sometimes more than a day).
The patient is usually agitated, groans, covered in sweat, tries to get into a comfortable position in which the pain causes less suffering.

Help

Provide the patient with complete rest and bed rest.
Call an ambulance (tel. 03).
Before the arrival of the doctor, do not feed, water the patient and do not give him medications!

Sudden pain that begins in the lumbar region is a sign of renal colic

Renal colic is a painful attack that develops when there is a sudden obstruction to the outflow of urine from the kidneys. The attack most often occurs with urolithiasis - during the passage of urinary stones from the kidney through the ureter to the bladder. Less commonly, renal colic develops in other diseases (tuberculosis and tumors of the urinary system, kidney injury, ureter, etc.).

More often, an attack of renal colic is manifested by a sudden, acute, excruciating pain in the lumbar region, extending along the ureters into the groin, genitals, and leg. The attack is accompanied by impaired urination, nausea, vomiting, flatulence.

With kidney stones, ureters, an attack often occurs for no apparent reason, with nephroptosis - after physical exertion, long walking. The attack is due to the stretching of the pelvis with urine with a delay in its outflow. In addition to these reasons, it may be associated with the presence of a blood clot in the urinary tract. The attack usually lasts several hours. In the interictal period, dull pain in the lumbar region may persist. Sometimes pain in renal colic is localized in the epigastric or iliac region, spreading to the entire abdomen. Concomitant dyspeptic phenomena, intestinal paresis, stool and gas retention, fever increase the similarity with diseases of the digestive system, in particular with such as acute intestinal obstruction, acute appendicitis, cholecystitis, gastric ulcer and duodenal ulcer, colitis, etc. Such renal colic with gastrointestinal syndrome is observed more often with ureteral stones and is very difficult to diagnose. From the listed diseases of the digestive system, renal colic with gastrointestinal syndrome can be distinguished by the following signs: sudden onset and end, restless behavior of patients, no increase in the severity of clinical manifestations during an attack, and other symptoms.

Signs

The attack usually starts suddenly.
The pain is initially felt in the lumbar region from the side of the diseased kidney and spreads along the ureter towards the bladder and genitals.
Increased urge to urinate.
Cutting pains in the urethra.
Nausea, vomiting.
The duration of renal colic is from several minutes to several hours.
Sometimes an attack with short breaks can last for several days.

Help

Provide the patient with rest and bed rest.
Put a heating pad on the patient's lower back or place him in a hot bath for 10-15 minutes.
Call an ambulance (tel. 03).

Acute intestinal obstruction

Intestinal obstruction - various pathological conditions with impaired evacuation of intestinal contents. Intestinal obstruction is divided into dynamic (due to intestinal spasm or paresis) and mechanical (blockage of the intestine by a foreign body, a ball of worms, gallstone, tumor, adhesions, etc.). In 70% of patients, obstruction is caused by postoperative adhesions in the abdominal cavity. The immediate cause of compression or infringement of the intestine can be a sudden tension of the abdominal press during physical work, a violation of the diet. The cause of intestinal volvulus is adhesions, long intestine length.

The disease begins suddenly, with cramping abdominal pain of varying intensity. The cramping character is more pronounced in the obstructive form (foreign bodies, worms, fecal stones, swelling). With strangulated obstruction (adhesions, volvulus, strangulated hernia), the pain is intense and constant; cramping pains are so strong that people moan and scream. There is no acute intestinal obstruction without pain. On this one sign, it can be assumed that there is an obstruction. In the later stages of the disease, the pain subsides and disappears. The second symptom is vomiting, there is a dry tongue, increased heart rate, lower blood pressure in the later stages, and bloating. Even later, there is a sharp soreness of the abdomen in all departments, stool and gas retention. In acute intestinal obstruction in the later stages, a high mortality rate is observed; to prevent this from happening, you must immediately call an ambulance. Treatment of this type of obstruction is operative. Taking laxatives is not recommended. You can take no-shpa or baralgin, which must then be reported to the doctor.

Exacerbation of peptic ulcer

In typical cases, an exacerbation of peptic ulcer disease is accompanied by a sharp pain in the abdomen some time after eating. Sometimes an attack of severe pain ends with profuse sour vomiting. In other cases, after reaching maximum strength, the pain gradually diminishes. Night pains are possible, pain on an empty stomach, weakening after eating. More often the pain is localized in the epigastric region (middle upper abdomen), less often in the right or left hypochondrium. Gives to the lower back, less often to the chest, even less often - down the abdomen. The pain in the abdomen increases with physical exertion, decreases in a motionless, bent position with the legs drawn to the stomach, as well as when the hands are pressed on the stomach. Constant abdominal pain is characteristic of ulcers that invade the pancreas. Peptic ulcer pain is often combined with heartburn and vomiting for relief. The patient's appetite is preserved, but there is a fear of eating due to fear of increased pain.

Acute gastritis

Sharp pain in the epigastric region occurs with acute erosive gastritis. At the same time, there is pain in the mouth, pharynx, along the esophagus, dysphagia, vomiting mixed with mucus, blood. Possible deterioration of the general condition of the patient, shock, collapse.

Exacerbation of chronic enteritis

Chronic enteritis is a disease characterized by inflammatory and degenerative changes in the mucous membrane of the small intestine. It can be combined with lesions of the large intestine (enterocolitis). The cause of this disease is past intestinal infections, giardiasis. The clinic is manifested by unsharp, dull, aching diffuse pain that occurs after eating or independently of it; a feeling of fullness, heaviness, swelling in the epigastric region and near the navel (these sensations intensify after eating and in the evening); decreased appetite or normal appetite; bloating and rumbling in the abdomen. The skin is dry, brittle nails, bleeding gums, weakness, fatigue are noted.

Exacerbation of chronic colitis

Chronic colitis is an inflammatory lesion of the colon mucosa. In its development, an important role is played by the use of coarse and insufficiently processed food, a large amount of carbohydrates, a lack of protein (in the summer, a large amount of raw vegetables and fruits prevails in the diet). Pain in the abdomen is minor, either diffuse in nature, or localized in the lower abdomen; there is a feeling of heaviness, burning, itching in the rectum; characterized by bloating, rumbling, soreness of the abdomen along the colon.

Pain in the abdomen with diseases of the heart, aorta

Gastralgic form with irradiation of pain in the epigastric region, the upper abdomen is observed in patients with myocardial infarction. The combination of abdominal pain with pain in the region of the heart is of great diagnostic value.

Features of pain syndrome in gastralgic form of myocardial infarction, its occurrence sometimes after an error in food or coincidence with an exacerbation of a stomach disease leads to the fact that patients are admitted to the hospital with the erroneous assumption of the presence of foodborne toxicity, acute appendicitis, acute cholecystitis or another form of acute surgical disease belly. In some cases, an exacerbation of a disease of the digestive system can be a provoking factor in the development of acute coronary insufficiency.

Pain in the upper abdomen occurs with a heart attack complicated by atrial fibrillation, pericarditis. The mechanism of abdominal pain in myocardial infarction overlaps with the mechanism of pain in respiratory diseases. In addition, with myocardial infarction, impulses may occur that disrupt the activity of the digestive system.

In relatively rare cases, the cause of abdominal syndrome in myocardial infarction is not only unusual irradiation of pain, but also the occurrence of acute pancreatitis, acute ulcers of the esophagus, stomach, intestines. Erosions, ulcers in the digestive system develop more often in the first days of myocardial infarction due to anoxia of the stomach and intestine wall caused by general hemodynamic disorders, increased vascular tone of internal organs, ischemic anoxia in the initial period of the disease, followed by stagnant anoxia.

Pain with such complications of myocardial infarction is persistent, accompanied by nausea, vomiting, bleeding from the stomach and intestines, and sometimes perforation of ulcers. A similar clinical picture can be observed in chronic circulatory failure.

A combination of abdominal pathology and chronic or acute coronary insufficiency is possible. With a peptic ulcer, diseases of the liver, biliary tract, stomach, pancreas, pain can be given to the region of the heart. Calculous cholecystitis and coronary atherosclerosis often develop in parallel.

Hiccups

Hiccups are involuntary, stereotypically repetitive, short and vigorous inhalation when the glottis is closed or sharply narrowed. It occurs due to the sudden convulsive contraction of the muscles of the diaphragm and larynx. The cause of hiccups can be irritation of the intestines, cooling of the body, emotional distress.

Help

Swallow a piece of ice;
or drink a few sips of cold water;
or squeeze the diaphragm area (above the lower back) with your hands;
or inhale the air quickly and deeply several times and exhale it very slowly.
with persistent hiccups, put a mustard plaster on the "epigastric" area of ​​the abdomen.
Do not drink water with your head held high, as the liquid can enter the respiratory tract.

When is it necessary to consult a doctor for abdominal pain

Pain that lasts for hours or even days is a serious symptom and you should get a medical examination as soon as possible. If the answer is yes to at least one of the following questions, you should consult a gastroenterologist:

Do you often experience stomach pains?

Does the pain you experience affect your daily activity and performance of work duties?

Are you experiencing weight loss or decreased appetite?

Is your pain accompanied by vomiting or nausea?

Do you see changes in bowel habits?

Do you wake up with intense abdominal pain?

Have you suffered in the past from diseases such as ulcers, cholelithiasis, inflammatory bowel diseases, surgery?

Do any medications you are taking have side effects from the gastrointestinal tract (aspirin, non-steroidal anti-inflammatory drugs)?

Urgent medical attention is needed for the following conditions:
- pain accompanied by fever, jaundice, dark urine, severe nausea or vomiting, light pasty stools;
- a sharp sharp stabbing pain in the abdominal cavity, accompanied by vaginal bleeding, an irregular menstrual cycle, pain radiating in the shoulders;
- severe persistent pain in the peritoneum after injury;
- unexpected very severe pain lasting more than 2 hours

Urgent hospitalization is required if the following symptoms appear:

abdominal pain accompanied by sudden bright red rectal bleeding or vomiting of blood or a substance that looks like coffee grounds;
dizziness, delirium, rapid pulse, cold clammy skin.

Diagnosis for abdominal pain

Correct pain assessment is very important. This symptom is of particular importance in acute diseases requiring emergency care to the patient.

Need to find out pain intensityin a stomach and if possible their localization (location)... With severe pain, the patient prefers to lie, sometimes in an uncomfortable, forced position. Turns with effort, carefully. The pain can be piercing (dagger), in the form of colic, or dull aching, it can be diffuse or mainly concentrated around the navel, or "under the stomach". It is important to establish the relationship of the onset of pain to food intake.

To determine the cause of the pain, the doctor may ask you the following questions: “Describe the pain you feel” (spastic, sharp, or dull), Is it persistent or intermittent? Where do you feel pain? Where did it appear? How long does it take? When does the pain start? (During your period? Does the pain get worse after eating?) More testing is likely to be needed.
The method of treatment will depend on the cause of the abdominal pain.

Which doctor to contact for abdominal pain

A doctor's specialization depends on the cause of the pain. The first doctor to be consulted is a general practitioner (general practitioner). He will send you for analyzes and, according to the results, will send you to a specialized specialist.

In case of acute abdominal pain, call an ambulance!

General blood analysis;
Blood chemistry;
Analysis for antibodies to Helicobacter;
Ultrasound of the kidneys and abdominal organs, pelvic organs;
Colonoscopy;
Analysis for markers of viral hepatitis;
Analysis of feces for dysbiosis;
X-ray contrast studies of the gastrointestinal tract;
MRI.

A decrease in hemoglobin and hematocrit in patients with abdominal pain is possible with intra-abdominal or gastrointestinal bleeding. Rapid blood loss, which often occurs with a disturbed ectopic pregnancy or rupture of a subcapsular hematoma of the spleen, can lead to small changes in hemoglobin and hematocrit levels until a redistribution of fluid from the extra- and intracellular space to the bloodstream occurs. A decrease in the level of hemoglobin and hematocrit in such cases also occurs after massive infusion therapy, carried out to restore the volume of circulating fluid. The low content of red blood cells suggests chronic blood loss, which can be observed both in malignant neoplasms of the gastrointestinal tract, and in benign diseases leading to gastrointestinal bleeding. Abdominal pain can occur with perforation of a chronic stomach or duodenal ulcer, as well as tumors of the gastrointestinal tract that have been the cause of chronic blood loss. A triad of symptoms, including cramping abdominal pain, signs of acute gastrointestinal bleeding, and low hemoglobin levels that occur after trauma, are highly likely to indicate hemophilia.

An increase in the number of leukocytes in the peripheral blood (leukocytosis) is a nonspecific symptom in patients with acute abdominal pain. Leukocytosis can be a manifestation of any inflammatory reaction or infectious disease. In addition, it is often found in pregnant women, in patients taking steroid hormones, and after splenectomy. Although in most patients with acute abdominal pain, the total number of leukocytes in the peripheral blood increases, it is not uncommon for acute inflammatory diseases of the abdominal organs to have a normal white blood cell count. Leukopenia can also be an important sign of the development of an infectious process, especially in the elderly and infants. Patients with severe leukopenia, even with mild abdominal pain, usually have a poor prognosis. Leukocyte blood count is often a more informative indicator of the developing infectious process than the total number of leukocytes. In most patients with inflammatory diseases of the abdominal organs, who have an abnormal number of leukocytes in the peripheral blood, the percentage of immature forms and precursors of leukocytes (the so-called shift of the leukocyte formula to the left), represented by stab leukocytes, myelocytes and metamyelocytes, is increased. These white blood cell precursors are released from the bone marrow in response to an inflammatory response in the body. As an example of the important value of the leukocyte formula in the examination of patients with abdominal pain, we can cite the fact that a normal number of leukocytes in the peripheral blood in combination with the absence of a shift in the leukocyte formula to the left occurs in only less than 5% of patients with acute appendicitis.

Emergency investigations for abdominal pain

• General clinical blood test for abdominal pain